Feeling bad

Traveling through time

April 3, 2014 Leave a Comment

We cannot return to the past; we can only go forward.

I had that thought this morning, pondering my life, my career, my current state. But I think it is likely that both parts of that thought are untrue.

We can go back and we can go forward, always and sometimes obsessively, in our minds. We do a lot of both. Sometimes I spend a lot of time in one place or the other, and sometimes just waffling in between. Remembering, for example, my mother’s death, or then her life, and wondering how much of my memories of her are based on “reality” of actual events in the world, and how much based on the reality of my child’s experience. And then flipping into some future where I have written about my life, and made sense of it all. And then flopping to another new future where I leave therapy as a career and do nothing, nothing at all. Or write, but somehow make a living at writing. Or reshape my therapy practice so I focus on groups and have more free time, or then I wonder if I don’t really embrace some idea I have for work, well, then, will I die feeling incomplete???

The point is that I am returning to the past over and over. I am slipping into the future again and again. And when I spend my days in those places I miss being alive. I miss what is actually going on.

Where can I find a balance so that I am living my life here and now, and also creating a future that conforms to my desires? Oh, that’s a point….all of this time travel is usually about control. It is about my desire to control my future and my rage that I could not control my past. Aha, yes, indeed.

I wonder if acknowledging that I want to CONTROL my future will help me let go of that deep desire. Actually, I don’t really want to control the future….I just want the outcomes to be the outcomes I want. It reminds me somehow of the prayers I was taught as a child. I was taught to ask God to bless parents, friends, the dog, and to keep everyone safe and happy. Somehow I believed that my supplication would protect people and keep outcomes the way I wanted them. That’s a pretty long history of wanting to control how things work out.

Maybe all I can do right now is try to limit my time traveling. Here and now can be a pretty good place. It can also be boring, sad, angry, irritable and cold. But the more time I spend in the present, the more life I am getting in my life. I guess I’ll try for that.

The ethics of “crisis-management” therapy

July 15, 2013 Leave a Comment

What kind of support do you need on your path?

I was thinking about practicing psychotherapy. Okay, I think about that a lot, and discuss it with my colleagues, and read about it and of course I also spend a bit of time actually practicing. I recently heard Randy Patterson talking about processes in therapy, and one of his thought-provoking questions was about therapy drop-out. What proportion of clients leave therapy before attaining their goals?

Apparently most practitioners will estimate about 20-25% but they will be wrong. The actual, documented typical drop out rate is more like 75-80%. So that includes the people who come once and don’t like you or the process, and also the people who work hard in therapy, start to feel better, but leave before actually accomplishing their goals.

I was just like the rest of the herd: roughly estimated that about 20 percent of people who come to therapy drop out. Upon reflection, I can see that the drop-out rate is a lot higher. Many people in therapy accomplish a lot even though they may not meet their goals, such as to no longer be depressed, or to get through a difficult situation. So even without meeting a goal, it isn’t therapy wasted. In fact, even for people who only come once or twice, the time, money, and energy are likely not wasted. When the client leaves, it may be that the process wasn’t meeting some need at that particular time, or that competing needs pushed therapy out. And in reality, the client’s goals might never actually be discussed, or defined. So the entire process, therapy, outcomes, termination, all of that might be very murky for both client and therapist.

But all that talk is just prelude to my title thought. People do leave therapy in various ways; leave angry, leave silently, leave with congratulations and great hurrahs for accomplishments They also return, and they return in various ways. If they leave in a way that feels okay to them, it makes it easier to return. And the other circumstance that makes a return to therapy easier is extreme distress.

It is not uncommon for clients to come to therapy in distress, get some relief, and, just as the therapist thinks it is time to really begin the actual THERAPY, the client leaves. Well, she got what she came for, which was relief. The problem is that if the underlying behaviour or thought pattern hasn’t changed, or maybe even hasn’t come into her awareness, she’ll likely be in a very similar distress again. So she returns to therapy and has a few sessions; feels quite a lot better, either due to the intervention, or to a change in external circumstances, or to that old placebo, time. So she leaves again…..only to return another time. Lasting change hasn’t happened; there has been, perhaps, a series of band-aids, or (better image) a step-wise movement that may be more lateral than progressive.

Is it okay to keep using band-aids when therapy might actually generate some real change ? Who makes that call? What does the ethical therapist do with this?

Day breaks, the crisis abates... — Day breaks, the crisis abates…

I don’t have an answer. Part of me thinks that it is disingenuous to just keep on with supportive counseling when I believe that a deeper, more focused type of work will be helpful in the long term. But another part of me acknowledges that for many people, symptom relief is a good thing and is sufficient. So whose goals are important here? It doesn’t make sense that my goals for your therapy should supersede YOUR goals for your therapy. But you also have less experience with therapy than I do, and you might not know what is possible.

Reflection tells me that I probably have to be honest with clients and tell them how I see it….that there is hope beyond just immediate relief from distress…but that the immediate gratification may not be there. Longer term therapies, like bioenergetic analysis which helps to restructure personality, or trauma treatments which heals through restructuring of distorted memories, can have outcomes that make a huge difference to the person. The path to those outcomes isn’t a smooth one, though, and often the courage it requires to take that path is hard to come by. So I can understand why someone might decide to use counseling as a symptom relief measure.

So ….. whose agenda, whose goals? Is feeling better a good enough goal for therapy? or do we have a better chance of getting change when we set goals that are more clearly defined??

These are some of the things I ponder. If I don’t find an answer, I usually look for chocolate. Which, in its way, performs the same soothing and comforting role as supportive counseling. Chocolate for everyone! Then back to pondering the deep thoughts.

Why I hate winter….but not really

January 6, 2013 Leave a Comment

I think possibly I have developed some faith.

I have been thinking about winter. It is hard to NOT think about winter, since we are smack in the middle of it here in Atlantic Canada. My smarter-than-me phone told me this morning it was ZERO degrees American. That’s cold, for me. When you translate to the 19.6 degrees Celsius it is less compelling for someone raised on the Fareinheit system, but zero….whew. It is winter.

Winter conjures a lot of negative stuff for me. Old family of origin stuff, of course. Winters were long and hard in Maine when I was a kid. My family was fairly poor, but only as poor as most of my classmates, so we all knew what it meant to have the house barely warm enough to keep the pipes from freezing, and that when we went out to play it was wearing extra layers of clothes we already had, not special technical fabrics or down or polyester filling to our coats and pants. Down was for rich people and polyester hadn’t been invented yet. So there was a lot of cold and wet involved in winter, and that special, awful, burning feeling in your hands and feet as they start to warm up again after playing outside for hours in the snow.

I also had the spectre of my mother, who was not a warm, positive influence at the best of times. She was at her worst in winter; felt closed in, imprisoned by winter and by being a mother-at-home without a car. So there are some negative things that just arise for me when it is cold and snowy.

I have worked hard to restructure that part of my brain. In 1994, when I moved from Louisiana to upstate New York, I was determined to make winter my friend. I got snowshoes. I got really excellent snow tires, four of them. None of that “all weather radial” nonsense for me; after my first accidental 360 with my all weather tires, I replaced them. I got cross-country skis and taught myself to use them. (Note: simply translating my running skills to skis was not a good strategy. It was years later that I had to unlearn a whole pile of bad habits). I put on extra sweaters, extra blankets, and sucked up the extra expense to have my house warm enough for me to feel okay.

Fast forward to now. I live in Canada. As my brother and his wife asked, in all kindness, “What were you thinking?” They, of course, live in balmy Chicago. But yes, I live in Canada and suffice it to say that I wasn’t thinking about winter when I made that decision. I am here now, though, and working through my negativity every single day. Every winter day, that is.

I heard on the radio that loveliest of winter expressions from Vivaldi’s The Four Seasons at the very same moment I reflected that in only 12 weeks, or less, actually, we’ll be celebrating the vernal equinox. And that’s the faith part. I have learned to have faith in the sun rising and setting, and in the days lengthening and shortening. Nothing stays the same but this pattern of change is something I can count on.

BUT…and this is a big BUT………I don’t want to spend the next twelve weeks wishing for winter to be over. That’s not okay with me; that’s like giving away three months of my life and I don’t have it to spare! So it isn’t enough to just grit my teeth and wish for spring, resisting what is actually happening in hope that the future will be different, better, a destination.

That’s a hell of a way to live your life, waiting for the next thing to happen. I think I have had enough of that.

I wonder how much of my childhood self is caught up in my winter blues? The self that didn’t have any hope for change, that had no capacity to take action on my own behalf, the child who was stuck in a family and home where unhappiness was always the order of the day….that’s who is awake and operating when my negative side starts to dominate.

So I need to reconnect with my faith in the pattern of life on this planet: because I can count on the sun, I don’t have to give my winter away to negativity and complaining. I can take care of me. I can notice how I feel and think about winter. I can sit quietly with those thoughts and feelings. I can remember how it was to be a kid in that setting, and also remember that I am no longer that child, no longer in that life. Now I have choices: I can ski, and snowshoe, and eat roasted root vegetables, and drink warm comforting drinks and be present to the winter, without wanting it to hurry by to get to spring. Some days I’ll likely resist the winter, and feel constricted and angry and frustrated by what I perceive as the limits of the season. Whether I resist or not, though, I know this: the sun will rise. The sun will set. The days will grow longer and then, in June, they’ll begin to grow shorter. No matter how I feel about any of it, this pattern of change will go on. On this I can depend.

Days of darkness

November 10, 2012 Leave a Comment

Dawn is easy to find this time of year, in New Brunswick. It happens so late in the day that most people who are not teenagers are likely to up when the sun appears. By the same token, the sun sets early, too….earlier and earlier for the next six weeks. I am grateful to be living here on Atlantic time. When I lived in Bangor, Maine, on Eastern time (but only a wee bit to the west of here), the sun was effectively gone from the sky well before four pm in latest fall. It always seems hard to me to go to work in the dark and return from work in the dark; to have all of the daylight hours taken by work, presumably indoor work. But when I lived in Maine, that four pm darkness was really hard to take.

We exacerbate the body’s struggle with the dark hours by adding a time change to the situation. The decision-makers don’t live here. They live in a more moderate, more temperate, more middle place, one where the length of day doesn’t fluctuate as much with the calendar. They may also live a more indoor life. When the light your body lives in is generated artificially, internal processes change. There are concrete, physiological reasons why people feel better in the summer, at least in this climate, and sun exposure is a part of that. So as the days grow longer, I get out my therapy lightbox and make sure that most days I get some sunlight or some light from the box. I notice the ways that we as a society create cultural experiences and values to help us get through this darkness. I carefully consider what I need and want to support me in feeling well and whole while the darkness feels encompassing. And I actively try to think positive thoughts about the dark days.

What changes do you notice in your body as the days get shorter?

How do you honour the body’s needs? Are you able to sit back and reflect on what you need during this time of year?

Can you notice the pull of social demands around the holidays and then choose whether and how to join in? More on that later….